Presentation (CTI)

OBJECTIVES: To rank selected therapy areas (TAs) according to level of public reimbursement friction across European markets, and assess feasibility for private-market patient access.
METHODS: A two-stage review searched official HTA and policy sources up to 1 June 2026 (NICE/NHS England, SMC, HAS, G-BA/IQWiG, AIFA, TLV, Zorginstituut Nederland, EMA, ECDC, WHO/Europe, PPRI). Stage 1 screened 39 TAs against seven predefined reimbursement-constraint signals; those with more than four signals advanced to Stage 2 (n=10). Stage 2 scored private-launch reliance across five equally weighted domains: patient-funded demand, delivery-channel feasibility, clinical governance burden, commercial viability, and equity/legal risk. Each domain was scored 1-5 (1=most constrained, 5=most favourable, based on four underlying indicators) and averaged into an overall feasibility score per TA.
RESULTS: Stage 1 narrowed 39 TAs to 10; restricted reimbursement (32/39) and cross-country variation (29/39) were the commonest constraint signals. Mean domain scores across the 10 TAs were highest for patient-funded demand (3.5/5) and commercial viability (3.2/5), and lowest for equity/legal risk (2.6/5) and governance burden (2.8/5). Obesity/weight management and erectile dysfunction were the most feasible (4.2/5 each), reflecting established self-pay precedent, straightforward delivery and light monitoring. Fertility/ART followed closely (4.0/5), supported by existing private-clinic infrastructure. Gene therapies/ATMPs (1.2/5) and Alzheimer disease-modifying therapies (1.6/5) were the least feasible: heavy monitoring requirements, scarce specialist infrastructure and prohibitive cost outweighed clinical need.
CONCLUSIONS: Patient demand was high across most TAs; feasibility hinged instead on whether delivery could be made safe and affordable outside hospital-based public systems. The most feasible TAs paired strong self-pay demand with simple delivery, while the least feasible were areas structurally incompatible with self-pay on cost or infrastructure grounds. Private-market therefore suits chronic, self-administered, low-monitoring conditions, whereas complex or high-cost therapies are likely to remain reliant on public funding.